Treatment, of Calculous Dhorders. 213 



occasioned by the too free use of alkalis, and I have more than 

 once known the white sand, thus produced, mistaken for the 

 effect of the medicine upon the stone itself, which the patient 

 was led to believe was in the process of solution or disintegra- 

 tion. It is in this way that the alkalis may do considerable 

 mischief, by increasing the facility with which the urine deposits 

 the phosphates upon the nucleus in the bladder, thus tending to 

 the very rapid growth of the stone. 



By minute attention to the history of a case, and by knowing the 

 treatment that has been pursued, I have sometimes been able to 

 foretel with some accuracy the nature and structure of the stone, 

 before its removal by operation. 



A patient who was cut for the stone in St. George's Hospital 

 by Sir Everard Home, informed me that about ten years previous 

 to his admission he had suffered pain in the right kidney, which 

 continued for many months, and ended in voiding a quantity of 

 gravel, which he had preserved, and which consisted of uric acid ; 

 his urine remained high coloured, and subject to a copious red 

 deposit, and in about three months he became sensible of there 

 being some extraneous body in the bladder, but was not suffi- 

 ciently annoyed by it to adopt any medical treatment. Two 

 years afterwards he had been exercising a restive horse, and on 

 his return home was seized with all the symptoms of stone of the 

 bladder ; he voided for some days a much larger quantity of 

 red sand than usual, and was directed to take soda water, 

 solution of caustic potassa, and lime-water, which he persevered 

 in almost constantly for two years and a half; he felt much 

 relieved, had suffered no pain in the affected kidney, and only 

 twice during the above period had been in much pain in the 

 bladder. He had almost constantly voided white sand, which 

 at last, during the use of the lime-water, became so copious as 

 to induce him to regard it as lime, and consequently to leave 

 off his medicines. About eighteen months previous to his ad- 

 mission into the hospital, a violent attack of pain came on in 

 the kidney, and he voided between twenty and thirty small uric 

 calculi with most excruciating pain. Uric acid now continued 

 so obstinately prevalent, that large doses of the alkalis did not 



